Transient ischemic attack: Difference between revisions
No edit summary |
No edit summary |
||
| Line 49: | Line 49: | ||
==Causes== | ==Causes== | ||
*See [[CVA | *See [[CVA]] | ||
== DDx == | == DDx == | ||
*See [[CVA | *See [[CVA]] | ||
== Work-Up == | == Work-Up == | ||
| Line 63: | Line 63: | ||
#CXR | #CXR | ||
#?MRI/MRA or ?neuro labs (ESR, lipids) | #?MRI/MRA or ?neuro labs (ESR, lipids) | ||
== Disposition == | == Disposition == | ||
=== AHA/ASA Guidelines === | |||
*Reasonable to hospitalize pts w/ TIA who present w/in 72 hr of symptom onset and have: | *Reasonable to hospitalize pts w/ TIA who present w/in 72 hr of symptom onset and have: | ||
**ABCD2 score of ≥ 3 | **ABCD2 score of ≥ 3 | ||
| Line 82: | Line 71: | ||
**ABCD2 score of 0-2 and other evidence that event was caused by focal ischemia | **ABCD2 score of 0-2 and other evidence that event was caused by focal ischemia | ||
=== | === NSA Guidelines === | ||
*Hospitalization for pts with first TIA w/in past 24-48hr | *Hospitalization for pts with first TIA w/in past 24-48hr | ||
*Recommended admission for pts w/ the following: | *Recommended admission for pts w/ the following: | ||
| Line 97: | Line 86: | ||
== Source == | == Source == | ||
*Stroke 2009;40[6]:2276 | *Stroke 2009;40[6]:2276 | ||
*Tintinalli | |||
[[Category:Neuro]] | [[Category:Neuro]] | ||
Revision as of 04:37, 29 September 2011
Background
- Definition: Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without infarction
- Should be viewed as analogous to unstable angina
Prognosis
- ABCD2 Score
- Risk of stroke at 2d, 7d, and 90d from TIA
- Although prognostic, evidence-based admission thresholds have not been determined
- Score
- Age >60yr (1 pt)
- BP (SBP >140 OR diastolic >90) (1 pt)
- Clinical Features
- Isolated speech disturbance (1 pt)
- Unilateral weakness (2 pts)
- Duration of symptoms
- 10-59 min (1 pt)
- >60 min (2 pts)
- DM (1 pt)
| Points |
Stroke Risk |
Two Days |
Seven Days |
90 Days |
| 0-3 |
Low |
1.0% |
1.2% |
3.1% |
| 4-5 |
Moderate |
4.1% |
5.9% |
9.8% |
| 6-7 |
High |
8.1% |
11.7% |
17.8% |
None with score <3 had CVA within one week in study
Causes
- See CVA
DDx
- See CVA
Work-Up
- Head CT
- Labs
- CBC
- Chemistry
- Coags
- ECG (a-fib)
- CXR
- ?MRI/MRA or ?neuro labs (ESR, lipids)
Disposition
AHA/ASA Guidelines
- Reasonable to hospitalize pts w/ TIA who present w/in 72 hr of symptom onset and have:
- ABCD2 score of ≥ 3
- ABCD2 score of 0-2 and uncertainty that diagnostic w/u can be completed w/in 2d as oupt
- ABCD2 score of 0-2 and other evidence that event was caused by focal ischemia
NSA Guidelines
- Hospitalization for pts with first TIA w/in past 24-48hr
- Recommended admission for pts w/ the following:
- Crescendo TIA
- Duration of symptoms >1hr
- Symptomatic carotid stenosis >50%
- Known cardiac source of embolus
- Known hypercoaguable state
- High risk of early stroke after TIA
See Also
Source
- Stroke 2009;40[6]:2276
- Tintinalli